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Introduction
Introduction
PACES is the practical examination part at the end of the MRCP exam course, allowing UK doctors to work as a medical registrar.
Format
Format
Paces underwent a revision in 2023. The new format has 5 clinical stations of twenty minutes each. Therefore the total exam is 100 minutes or 1 hour 40 mins.
Summary
Examination stations x4: one of neurology, respiratory, cardiovascular and abdominal (10 mins each, 40% total time)
Consultation stations x2 (20 mins each, 40% total time)
Communication stations x2 (10 mins each, 20% total time)
5 minute breaks
Communication & examination stations, you required to go into the next station without a break or time to read the blurb
Consultation stations will have 5 minute of preparatory reading
Examination Stations
Examination Stations
Skills assessed:
Examination (6 minutes)
Performance
Eliciting signs
Discussion (4 minutes)
Presentation
Examiner Questions
Timings
5 minute break: the blurb is usually very short and you'll have no time to prepare when paired with the communication stations.
10 minute station:
Examination 6 minutes
The examination will finish after 6 minutes. For practice I would allow 5 minutes for patients and 4 minutes on friends. The examination should be slick and be able to be completed in that time, however if there is a sign you're unsure of this can really slow you down.
Examinations Assessed
In this station you'll only be asked to perform:
Nervous System Examinations: 90% will be either- cranial nerves, upper limb or lower limb
A. Examination Performance
Within the whole of paces, this is the area you know will come up. Therefore there is high examiner expectations that you should be able to complete the examination effectively. There is no excuse for not practicing it until it is second nature. Some of the examination maneuvers can be more difficult when performed with signs.
B. Eliciting the signs
Arguable the hardest part of the exam is reliably eliciting the signs- and this is the commonest cause of failure. Some examinations may have only one sign (e.g. hepatomegaly) and your whole station can be failed on your inability to elicit the correct signs. In theory they should be clear and obvious. Another difficult is indecision is not tolerated- either there is hepatomegaly or not. Some signs you can mitigate- e.g. there was a systolic murmur, however you should be able to distinguish ejection systolic from pansystolic.
C. Presenting the signs
Paces is an oral exam and the importance of presentation is easily underestimated. Firstly, you'll need to describe your physical signs and it can be very easy to not be able to remember them all whilst presenting. This requires plenty of practice. A rough structure is signs, differentials, signs of organ decompensation/ severity, underlying aetiology and medication side effect evidence and potientially moving onto completing your assessment, investigations and management. It is important to be clear and confident, even if you are unsure of your findings.
D. Examiner Discussion
This is the most unpredictable part of the station and likely the lowest yield. A good presentation with the correct signs will usually be a pass so the examiner discussion can be slightly academic. Regardless the questions usually follow the structure, suggested in the presentation. This is: your positive findings, differentials, signs of severity, aetiology, therapy side effects, completing your assessment, investigations and management. For the common conditions, you should be able to say something for these questions.
Check our more in depth pages for more information:
Consultation Stations
Consultation Stations
Timings
5 minutes prepartory reading
20 minute station
15 minutes: patient- history, examination and explanation
5 minute: examiner- presentation and discussion
Strategy
Prepare structure in 5 minutes preparation
A detailed, particularly HPC should prompt a good differential and examination
History should include- PMH, DHx, Allergies, FHx, SHx, ICE; systemic enquiry and consider travel, sex and pet history
Patients will have a key concern, elicit this and note if they repeat this concern
Usually these stations are either
First diagnosis of core 'PACES conditions', e.g. Phaeochromocytoma
Common presentation in the context of a core 'PACES conditions'- headache in acromegaly
Presentation
First question will usually be please present your positive findings and similarly it can be easy to not have a structure due to the rushed nature, if there is complexity, make sure to note down your examination findings
You may be asked to summarise the case or handover the patient
Usually questions follow the differentials, investigations & management structure
For more information: see Consultation Station.
Communication Stations
Communication Stations
The communication stations are often felt to be the easiest because of the lack of clinical knowledge required. They are important contributors to the overall mark and pockets of knowledge can be invaluable. In this station, your clinical knowledge is not assessed therefore if you don't know, you won't be marked down for stating this- but if you state something incorrect you will be.
Timings
5 minutes break reading blurb and prepping
10 minutes total: all discussion with patient (no examiner questions at the end)
Patient Discussion
Take it slow, pause, let the patient lead this around their concerns and beliefs
Patient will have a key concern- address this immediately (not at the end)
If the patient repeats something- this will be delibrate and ask more about it
Summarise towards the end
Thank patient at end
Core topics:
Clinical
New diagnosis of core chronic condition: diabetes, asthma, COPD, epilepsy, ADPKD, migraine
Explanation of core procedure: lumbar puncture, ascitic drain, chest drain
Communication focused
Breaking bad news- new diagnosis or end of life scenario
Consent, capacity, confidentiality; power of attorney, next of kin- DNR
Complaints procedure, duty of candour, unhappy/ abusive patient or relative
For more information: see Communication Station.
Written in 2026.
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